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Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations

Institute of Medicine

September 24, 2009

The influenza pandemic caused by the 2009 H1N1 virus underscores the immediate and critical need to prepare for a public health emergency in which thousands, tens of thousands, or even hundreds of thousands of people suddenly require and seek medical care in communities across the United States. In the event of such emergencies, officials rely on standards of care policies and protocols to protect the public’s health. As the nation prepares not only for the 2009 influenza pandemic, but for any disaster scenario in which the health system may be stressed to its limits, it is important to describe the conditions under which standards of care would change due to shortage of critical resources.

At the request of the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services, the Institute of Medicine convened a committee to develop guidance for crisis standards of care that should apply in disaster situations—both naturally occurring and manmade—under scarce resource conditions. The committee’s report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations, is focused on articulating current concepts and guidance that can assist state and local public health officials, healthcare facilities, and professionals in the development of systematic and comprehensive policies and protocols for crisis standards of care in disasters where resources are scarce. In addition, the committee provides guidance to clinicians, health care institutions, and state and local public health officials for how those crisis standards of care should be implemented in a disaster situation.